Transcript Classification of anemia

Classification of anemia
Causes of anemia
Red cells size and their indices
-Blood loss.
-Hb concentration and Hematocrit
-Iron deficiency.
-MCV, MCH, MCHC.
-Infection.
-RBC destruction (hemolysis)
e.g. G6PD.
-B12 and Folate deficiency.
MCV
-IDA
-Thal
MCV
Normal MCV -B12
-Folat
-hemolytic
anemia
Iron deficiency anemia
Normal iron metabolism:
-The primary function is oxygen transport.
-Iron is absorbed by duodenum and jejunim
-Average total body iron content 3500-4000 mg.
-Approximately 2/3 found in hemoglobin,
-Iron is also stored in RE cells (BM, Spleen and liver)
as hemosiderin and ferratin.
-Also iron found in myglobin and myeloperoxidase and
in certain electron transfer.
-Iron is more stable in ferric state (Fe+++) than in
ferrous state (Fe++).
Iron + Hem
Iron Metabolism
Daily Fe++ turnover continuous process
RBC
2500 mg
Via RE system
90% extra vascular
5-10% intra vascular
R.E. 20 mg
Released daily
Iron Absorption
1-2 mg only
Plasma Fe
Transferrin carriers
4 mg
20 mg Fe
Returned to immature RBC
in BM
Loss (from GI tract)
1-2 mg daily
Body stores
1000 mg (M)
300-500 mg (F)
Myglobin
300 mg
Dietary iron:
Iron is present in food as ferric hydroxides (ferric-protein complexes
and hem-protein complexes).
-meat, liver
-vegetables, eggs.
-The average diet contains 10-15mg and only 5-10% is normally
absorbed.
Iron requirements:
It varies depending on sex and age:
Male/female
0.5-1 mg/day
Pregnant female 1-2 mg/day
Children
0.5 mg/day
Clinical features:
•
•
•
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When ID is developing, the RE stores (hemosiderin and ferritin)
become completely depleted before anemia occurs.
At an early stage, no clinical abnormalities.
Later, patient may develops general symptoms and signs of
anemia.
In severe case of IDA ridged or spoon nails.
Causes:
• Chronic blood loss
Fetomaternal Hemorrhage, inherited
bleeding disorders menstrual peroid.
• Maternal iron deficiency (neonate).
• Growth spurts (infants and children).
• Gastrointestinal,
peptic ulcer, aspirin ingestion, carcinoma,
hookworm, colitis, piles etc.
• Pregnancy
• Rarely hematouria,
self-inflicted blood loss, hemoglobinuria.
• Insufficient daily iron intake (poor diet).
• Malabsorption.
Laboratory findings:
•Red cell indices:
Low Hb conc.
MCV, MCH, MCHC* 
•Blood film:
Hypochromic microcytic Picture.
Occasional Target cells.
Pencil shaped poikilocytes.
Normal reticulocyte count.
•Bone marrow iron:
Normal to hypercellular.
RBC precursors are increased in number.
Iron stain negative.
•Chemical testing on serum:
Serum iron
Decreased
Transferrin/TIBC
Normal to High
Serum ferritin
Decreased (Very low)
Hypochromic Microcytic picture (IDA)
-ve
BM Iron Stain
+ve
Reticulocytes